Alternatives to enucleation in the management of choroidal melanoma.

Over the past 15 years 140 patients with choroidal melanoma have been treated by local surgical resection of the tumour. The method appears worth considering for tumours up to 15 mm in diameter not involving more than one-third of the ciliary body. Sixty percent of patients retained useful vision and 25% good vision. Eighty-two percent retained a cosmetically satisfactory eye. The total tumour-related mortality in this group of patients was 9%, almost all of the 12 patients dying having had tumours larger than would now be recommended for local resection. The five-year survival rate among patients undergoing local resection was 84%. Low-energy long-exposure laser has been used to treat a small number of choroidal tumours. The technique appears useful for tumours up to 10 mm in diameter and not more than 3 mm in thickness. Ruthenium plaque therapy has also been used in some cases and appears a suitable method of treatment for tumours up to 10 mm in diameter and not more than 6 mm in thickness. The options for conservative management of choroidal tumours are greater with small tumours than with large ones except in only eyes, tumours of over 15 mm in diameter are best treated with enucleation. The long-term survival after all forms of conservative management has not yet been established. At present the use of controversial techniques such as local resection should be restricted to a few centres so that adequate statistical evaluation of the method may be made.